Liposuction is a great tool for reducing undesirable pockets of fat. We tend to collect fat in genetically-determined areas. In women, this tends to be the lower abdomen, upper abdomen, flanks (muffin-top area) and upper thighs. This fat tends to be the “last to go” during weight loss, as it is the low metabolism storage fat our bodies save for the long, hard winter! Men tend to store fat in the lower abdomen and flanks (spare tire area).
The best candidates for liposuction are those who are at or close to their ideal weight, but have fatty deposits they can’t get rid of. I ask patients to try and get their weight where the rest of their body looks good, and then we can sculpt the excessive areas into submission, creating pleasing contours.
Unfortunately, liposuction is not a great way to lose weight. Only a few pounds of fat can be extracted at any one time. But it is “spot reduction” in that the fat is only gone from where it is suctioned and not from anywhere else.
The tricky thing about liposuction is that it is kind of like letting the air out of a balloon. When you reduce the fat, you reduce the volume that is filling the skin. So the skin is looser afterward. The skin does tighten to a degree, but the amount of tightening varies from person to person. Younger patients do better than older patients in the skin-tightening department. If your skin doesn’t tighten enough, you can sometimes end up with shadows or contour irregularities. I have seen many patients who underwent liposuction and either had too much fat removed, or they had skin that was too loose to begin with, and they end up with saggy skin. This happens when the patient visits a liposuction center that only does liposuction, so that’s all they can recommend. If the patient is not a good candidate for liposuction, but has it done anyway, then she may end up unhappy and having to spend more money to remove the excess skin. So it’s important to be evaluated by a plastic surgeon that performs both liposuction and skin tightening procedures, and who can give you the best and most cost-effective options for your problem areas.
Another word to the wise: regular old liposuction is still the best, most reliable treatment for problem fat. Fancy liposuction names such as “smart”, ultrasonic, or “whatever” are no better, just more expensive, because you also have to pay for the use of the fancy machine. The manufacturers of these machines will sell them to anyone, so you need to carefully evaluate the credentials of the liposuction doctor. Make sure the doctor is a board-certified plastic surgeon. Otherwise, you may end up with a doctor who is not even a surgeon, and who learned how to do this procedure by taking a weekend course!
Liposuction of small areas can be done with only local anesthesia. Larger areas are difficult to adequately numb, and so we provide sedation or general anesthesia, so that you will be comfortable. There are centers that will suction large areas using only local anesthesia, but it can be very uncomfortable! I prefer my patients to be as comfortable as possible, so that I can do the very best job for them. Sedation, or even a short general anesthetic, is very safe, and makes the whole procedure so much easier on both you and your surgeon.
After liposuction, you are placed into a “pressure garment” which is tight underwear that helps keep down the bruising and swelling. You normally wear this garment for 3-4 weeks, just removing it to shower for the first two weeks, and then taking it off at bedtime for the second two weeks. Swelling actually takes 6-8 weeks to disappear completely, and then it’s another 6-8 weeks for the skin to snug up as much as possible. One month after liposuction, most patients look pretty good, but they will look better after month two, and a little better yet after month three. Usually by the end of month four, the healing is completed. You need to avoid vigorous physical activity for the first two weeks, but then you can return to the gym and work your way back to your normal routine of exercise. By about two months after surgery, your weight should be what it was on the day of surgery, minus the amount of fat removed during liposuction, and that should be the weight you maintain from then on. If you unfortunately gain weight after liposuction, it can cause fat to appear in different locations such as the breasts, back, or arms, etc. that can look a little bulky.
My best advice is to work on getting your weight as close to ideal for you as possible, through diet and exercise. If, after that, you have stubborn pockets of fat you can’t abide, come see me to find out if liposuction might be a good solution for you.